Solid Organ Transplantation is not a Risk Factor for Eosinophilic Oesophagitis: A Review of 13,792 Transplants Performed on a Predominantly Adult Population in North Carolina

Abstract

Introduction: Case reports in the paediatric literature suggest that solid organ transplantation, medications used to treat potential rejection (such as calcineurin inhibitors), or post transplant lymphoproliferative disease (PTLD) may be a risk factor for eosinophilic esophagitis (EoE). This association has not yet been examined in an adult cohort. Methods: A retrospective search of the Carolina Data Warehouse (a central data repository of clinical, research and administrative data for a tertiary health system) for all patients (adult and paediatric) with documented solid organ transplantation (concurrent or previous recipients of heart, kidney, liver, lung, pancreas, single or in combination) at the University of North Carolina, using records attained between January 1 2009 and April 1 2017. Cases of EoE and solid organ transplantation were identified using ICD 9 and 10 coding, and co-morbidity identified using electronic data extraction tools. EoE cases were compared to a pre-established research database to confirm complete case identification. The electronic medical records of cases were interrogated. Age, gender, pre-transplant diagnosis leading to organ transplantation, date of solid organ transplantation, date of diagnosis of EoE, type of solid organ transplantation, medications and substance use was recorded. Results: Of 13792 individuals who received a solid organ transplant, 5 cases were found to have EoE (estimated period prevalence equivalent to 36.25/100,000 people). Only adult cases of EoE were noted. The current mean age of the cases of EoE was 42.8 years (range 21-60), 3/5 were male (60%), and 3/5 (60%) had comorbid atopic illness. Renal, combined renal and pancreas, combined renal and liver, liver and heart transplantations (respectively) were received. PTLD was not diagnosed. All cases received the solid organ transplantation prior to the diagnosis of EoE (mean 11.8 years, range 4 to 18 years). All cases used some form of immunosuppression [tacrolimus monotherapy (2 patients=40%), tacrolimus with mycophenolate (2 patients=40%), sirolimus monotherapy (1 patient=20%)]. Conclusion: The prevalence of eosinophilic esophagitis was not more common in a mainly adult cohort of solid organ transplant recipients. The use of tacrolimus was predominant in this cohort, and may be of significance.[1] Further research could focus on why EoE could develop on concomitant immunosuppression.